Status epilepticus (SE) is a common pediatric emergency encountered in the prehospital situations and in the emergency administration of anticonvulsants, which will cause the seizures to cease. Although prognosis is primarily determined by the etiology, the duration of SE and therapy administered have unequivocal impact. If the seizures last longer than 1 hour, homeostatic mechanisms may start to fail. A dynamic multidisciplinary approach is essential in seizure management. The emergency physician has a unique responsibility to provide state-of-the art therapy and individualize the involvement of other services. The input of the pediatric intensive care physician is critical and assumes a major role if the patient fails to respond to first-line therapy. The treatment of refractory status epilepticus requires labor-intensive hemodynamic support and suppression of central nervous system, with either an anesthetic agent or a barbiturate. There is an urgent need to formulate guidelines for management of refractory status epilepticus.